Provider Demographics
NPI:1619401676
Name:N & R OF SPRINGFIELD MONTCLAIR LLC
Entity Type:Organization
Organization Name:N & R OF SPRINGFIELD MONTCLAIR LLC
Other - Org Name:SPRINGFIELD VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:1100 E MONTCLAIR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5076
Mailing Address - Country:US
Mailing Address - Phone:417-820-8500
Mailing Address - Fax:417-820-8503
Practice Address - Street 1:1100 E MONTCLAIR ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5076
Practice Address - Country:US
Practice Address - Phone:417-820-8500
Practice Address - Fax:417-820-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043573314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107807604Medicaid
MO265814Medicare Oscar/Certification